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The New Jersey Department of Health is working with the Somerset Health Department on two measles exposures situations. NJDOH has recently identified a second person suspected of having measles who may have exposed additional people at Somerset Medical Center and the public at several locations in Somerset County between March 6 and 12.

This person had suspected contact with a known laboratory confirmed case of measles in an unvaccinated individual who recently traveled internationally. This person potentially exposed persons visiting the following locations at the dates and times specified:

Somerset Medical Center, 110 Rehill Ave., Somerville, NJ 08876
March 6, 9:00 a.m. – 4:30 p.m.
March 7, 9:00 a.m. – 8:00 p.m.
March 8, 9:00 a.m. – 2:00 p.m.
March 11, 8:45 a.m. – 2:00 p.m.

Steeplechase Cancer Center, 30 Rehill Ave., Somerville, NJ 08876
March 6, 2:30 p.m. – 5:30 p.m.
March 8, 12:00 p.m. – 5:30 p.m.
March 11, 2:00 p.m. – 5:00 p.m.

Somerset County Human Services Building, 27 Warren St, Somerville, NJ 08876
March 6, 9:15 a.m. – 2:00 p.m.
March 7, 10:30 a.m. – 7:00 p.m.
March 11, 10:30 – 4:00 p.m.

Somerset County Administration Building, 20 Grove St, Somerville, NJ 08876
March 7, 10:00 a.m. – 12:30 p.m.

Carlo’s Pizza & Pasta, 572 Union Ave, Bridgewater, NJ 08807
March 8, 4:00p.m. – 6:45 p.m.

T.G.I.Friday’s, 395 U.S. 202, Bridgewater, NJ 08807
March 9, 5:30 p.m. – 10:00 p.m.

Barnes & Noble Booksellers Somerville, 319 Rte 202/206, Bridgewater, NJ 08807
March 9, 8:00 p.m. – 10:30 p.m.

Bloomingdale’s at Bridgewater Mall, 410 Commons Way, Bridgewater, NJ
March 10, 3:00 p.m. – 6:30 p.m.

Adam & Eve Hairstylists, 626 U.S. 206, Hillsborough, NJ 08844
March 12, 6:00 p.m. – 9:00 p.m.

At this time, this person is suspected to have measles. Test results are pending.

The NJDOH is also working with Somerset County Health Department on a previous exposure. On March 8th, the local health department was made aware of an employee at Somerset Medical Center who developed fever and a rash. This person had contact with a known laboratory confirmed case of measles in an unvaccinated individual who recently traveled internationally. The person worked while potentially infectious, potentially exposing persons visiting Somerset Medical Center during the following dates and times:

March 4, 8:00 a.m. – 6:00 p.m.
March 5, 8:00 a.m. – 6:00 p.m.
March 6, 8:00 a.m. – 2:00 p.m.

On March 13th, NJDOH received laboratory confirmation of measles for the employee, making it a confirmed case.

Individuals who might have been exposed are urged to contact their healthcare providers to discuss their exposure and risk of developing illness.

Anyone who suspects an exposure is urged to call their healthcare provider before going to the medical office or emergency room so that special arrangements can be made to minimize exposure in the healthcare setting.

All health care personnel should have documented evidence of measles immunity on file at their work location. Having high levels of measles immunity among health care personnel and such documentation on file minimizes the work needed in response to measles exposures, which cannot be anticipated. Health care facilities should review their current policies regarding acceptable proof of immunization for health care personnel. Please view the MMWR for the ACIP/CDC current recommendations:

http://www.cdc.gov/mmwr/pdf/rr/rr6007.pdf

For more information, please visit www.nj.gov/health under the “Hot Topics” section for Measles Frequently Asked Questions pertaining to clinical staff and the general public.

Measles Overview
Measles is a highly contagious disease that is transmitted by respiratory droplets and airborne spread. The disease can result in severe complications, including pneumonia and encephalitis. The incubation period for measles ranges from 7 to 18 days. Individuals are infectious 4 days before and after rash onset. The diagnosis of measles should be considered in any person with a generalized maculopapular rash, fever, and cough, coryza, or conjunctivitis. Immunocompromised patients and patients who are not fully immune may have an atypical presentation.

Recommendations
Health care providers should maintain vigilance for measles importations and have a high index of suspicion for measles in persons with a clinically compatible illness who have traveled abroad or who have been in contact with travelers. They should assess measles immunity in U.S. residents who travel abroad and vaccinate if necessary. Measles is endemic in many countries, including popular travel destinations. Suspected measles cases should be reported immediately to the local health department, and serologic and virologic specimens (throat/nasopharyngeal swabs and urine) should be obtained for measles virus detection and genotyping. A culture is preferable to serology in vaccinated individuals. Laboratory testing should be conducted in the most expeditious manner possible.

Preventing Transmission in Health Care Settings
To prevent transmission of measles in health care settings, airborne infection control precautions (available at http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html) should be followed stringently. Suspected measles patients (i.e., persons with febrile rash illness) should be removed from emergency department and clinic waiting areas as soon as they are identified, placed in a private room with the door closed, and asked to wear a surgical mask, if tolerated. In hospital settings, patients with suspected measles should be placed immediately in an airborne infection (negative-pressure) isolation room if one is available and, if possible, should not be sent to other parts of the hospital for examination or testing purposes.

As an added precaution, hospital Emergency Departments are encouraged to provide signage which directs staff and/or patients to identify anyone presenting with fever and rash.

In Summary
1) Report all suspect measles cases (febrile illness accompanied by generalized maculopapular rash) immediately (DO NOT WAIT FOR LABORATORY CONFIRMATION) to the local health department. If unable to reach the local health department, notify the NJDOH Vaccine Preventable Disease Program during regular business hours at (609) 826-4860. After business hours, or on the weekend, call NJDOH at (609) 392-2020.
2) Place all patients with suspected measles in airborne isolation immediately.
3) Obtain clinical specimens for diagnostic testing from blood (for both IgM and IgG to measles), urine, nasopharyngeal aspirates/throat swabs.
4) Determine the immune status of contacts. Offer measles vaccine or immune globulin to susceptible exposed contacts as appropriate. Quarantine contacts who cannot produce documentation of immunity from day 7 through day 18 following exposure.
5) Assure that all those eligible for MMR vaccine receive appropriate and timely vaccination.

Additional information is available at through the Centers for Disease Control and Prevention website at http://www.cdc.gov/measles/index.html

Thank You,
Christina

Christina Butieb-Bianco
Public Health Emergency Notification System Coordinator
Hudson Regional Health Commission
595 County Ave. Building 1
Secaucus, NJ 07094
Phone: 201-223-1133
Fax: 201-558-0691
Email: cbutieb@hudsonregionalhealth.org or cbutieb@njlincs.net
Web: http://www.hudsonregional.org/
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